Age-related hyperkyphosis: update of its potential causes and clinical impacts—narrative review

Abstract

The present study aims to qualitatively review the contributing factors and health implications of age-related hyperkyphosis. We conducted a narrative review of observational and cohort studies describing the risk factors and epidemiology of hyperkyphosis from 1955 to 2016 using the following key words: kyphosis, hyperkyphosis, posture, age-related hyperkyphosis, kyphotic posture, aetiology and causes. This review included 77 studies. Approximately 60–70 % of the most severe hyperkyphosis cases have no evidence of underlying vertebral compression fractures. Other proposed factors contributing to hyperkyphosis are degenerative disc disease, weakness of back extensor muscles and genetic predisposition. Strength and endurance of back extensor muscles are very important for maintaining normal postural alignment. Recent evidence suggests that age-related hyperkyphosis is not equivalent to spinal osteoporosis. Due to the negative impact of hyperkyphosis on physical function, quality of life and mortality rates, physicians should focus not only on osteoporosis, but also on age-related postural changes. More research about the relationship between spinal morphology and modifiable factors, especially the structural and functional parameters of trunk muscles, could further illuminate our understanding and treatment options for hyperkyphosis.

Postural alignment of patients with Chronic Obstructive Pulmonary Disease

“…Usually, thoracic kyphosis undergoes changes with aging, as it is often related to aspects such as, osteoporosis, obesity, sedentary lifestyle and muscular weakness (22,23,24,25), which are commonly observed in elderly individuals.…”

Genetic Studies of Endophenotypes From Spine CT Scans Provide Novel Insights Into the Contribution of Mechanosensory Pathways to Vertebral Fractures and Spinal Curvature

“…Classically a 'Dowager's Hump' (for which the term kyphosis originates from the Greek kyphos, a hump) is observed in the older female population who are at relatively high risk of osteoporosis. Women reportedly develop kyphosis earlier in life and to a greater degree than men (20) . Conceivably, older females with spinal kyphosis may have a higher proportion of underlying vertebral fractures versus degenerative changes as compared with males, which would lead to distinct sexspecific heritability estimates and genetic correlations with other endophenotypes.…”

“…Women reportedly develop kyphosis earlier in life and to a greater degree than men. (20) Conceivably, older females with spinal kyphosis may have a higher proportion of underlying vertebral fractures versus degenerative changes compared with males, which would lead to distinct sex-specific heritability estimates and genetic correlations with other endophenotypes. Consistent with this suggestion, monozygotic twin studies have identified sex-specific differences in heritability of BMD.…”

Pathomechanisms and management of osteoporotic pain with no traumatic evidence

“…Thus, these changes in the muscle cause LBP even for a short period (e.g., while standing and walking) [29][30][31][32][33][34][35][36] . The relationship between spinal kyphosis and the structural and functional parameters of trunk muscles should be investigated 36) . A previous basic study suggested that the involvement of inflammation of the fascia in the back could alter the gait pattern in rodents 37) .…”